Determinants of Child Health in Developing Countries – Social, Environmental, and Policy Perspectives

Abstract

Child health has been on top of the global health agenda since the Millennium Development Goal era ending in 2015. It is well recognized that a vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development. The determinants of child health are multifaceted. In this dissertation, several factors affecting children’s healthy development are explored. Using nationally representative data from Jamaica, Chapter 1 focuses on the effects of a health policy on child health, via empirically examining how the national-wide user-fee-removal policy affects children’s care seeking behavior and the financial burden their families faced, with an equity focus among children of various wealth levels. I found that in the short-term, the policy deteriorated equity of access to health care for children as the richer families appeared to benefit more; while the equity status improved fast in the medium-to-long-term as the poorer children caught up. Besides the effects of health programs, I further examine the cost of scaling up the health intervention in Chapter 2, and perform cost-effectiveness analysis (CEA) of a nutritional package program (Yingyangbao [YYB]), which is a nutrient-dense food supplement targeting infants and young children, on children’s stunting status in the context of China. Different from the traditional CEA study, I use extended cost-effectiveness analysis (ECEA) method to assess the distributional impact of YYB rollout across provinces and socioeconomic groups. Our result shows that YYB could be a pro-poor intervention that brings substantial health benefits to poor Chinese children, but with large variations across provinces from as low as ¥800 (Chongqing province) to as high as ¥23,400 (Jilin province). The determinants of child health are multi-dimensional. Many factors are beyond the reach of health sector, and require multisectoral effort to support childhood development. In Chapter 3, I assess the impact of an environmental factor on child health, via examining how prenatal exposure to sand-and-dust storms (SDS) affects children’s cognitive development using nationally representative data from China. I find prenatal SDS exposure is strongly associated with lower mathematics and word-recognition test scores, as well as additional months to begin speaking in sentences. Despite the findings of this thesis, more work should be conducted to identify mechanisms behind the findings, such as the scientific pathway for pollutant to affect cognitive development.